Mind and Body

Tests May ID Older Patients at Risk for Post-Op Delirium

Two simple tests may predict which older patients have underlying depression or less cognitive flexibility, leaving them vulnerable to post-surgery delirium, says a study presented at a meeting of the American Society of Anesthesiologists.

Delirium, a state of extreme confusion that can be short-lived or more long-term, can be frightening to families and costly for the health care system, explains study author Dr. Terri Monk, at Duke University School of Medicine.

A recent study showed that health care costs go up another $2,500 for each patient with delirium following surgery, because of longer hospital stays, higher death rates, and the need sometimes to admit patients to long-term care.

The annual national cost may reach as high as $152 billion a year, says Dr. Monk.

"When you look at the increase in the aging population, this is going to be more of a problem," she adds.

Increasing Concern as Population Ages

Dr. Arnold Berry, at Emory University School of Medicine in Atlanta, says the impact of the problem is already clear, considering that about 12 percent of the US population is 65 or older and this group accounts for one-third of expenditures on surgery.

The Duke study of 100 patients, average age 65, found that 16 percent experienced post-operative delirium after they had received general anesthesia for non-cardiac surgery.

Specific percentages can be as high as 50 percent or more for patients having surgery following a hip fracture, notes Dr. Monk.

The two pre-surgery tests - the Geriatric Depression Scale-Short Form and the Trail Making Test - can be administered by nurses and other health care staff in as little as 15 minutes.

Verifying these tests as effective screening tools could prompt further research to identify measures to prevent or reduce post-operative delirium.

Screening Tools May Help

Dr. Monk says further research might show that treating depression in older patients prior to elective surgery may reduce their likelihood of post-operative delirium.

Dr. Berry, who leads a group of anesthesiologists interested in geriatric issues, says Dr. Monk's findings are "one piece to a big puzzle."

Because of changes in the aging brain, it is difficult to determine how much the stress of surgery and how much the anesthesia add to the risk of post-operative delirium, he says.

Dr. Berry explains that the Duke study identifies screening tools that could spur more research into ways of dealing with both factors as they relate to post-op delirium.

He says he does not plan to add the screening tools used in the Duke study to his pre-operative work-ups - at least not yet. He is awaiting further study and confirmation of the findings.

Always consult your physician for more information.

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January 2009

Anesthesia Explained

During surgery, you will be given some form of anesthesia - medication administered for the relief of pain and sensation during surgery. The type and dosage of anesthesia is determined by the anesthesiologist.

When a patient faces surgery, he or she will meet with the anesthesiologist or nurse anesthetist before the procedure. The anesthesiologist will review the patient's medical condition and history to plan the appropriate anesthetic for surgery.

There are various forms of anesthesia. The type of anesthesia you will receive will depend on the type of surgery and your medical condition. Usually, an anesthesiologist will administer a sedative in addition to the anesthetic.

Anesthesiologists are the physicians trained to administer and manage anesthesia given during a surgical procedure. They are also responsible for managing and treating changes in your critical life functions - breathing, heart rate, and blood pressure - as they are affected by the surgery being performed.

Further, they immediately diagnose and treat any medical problems that might arise during and immediately after surgery.

Prior to surgery, the anesthesiologist will evaluate the patient's medical condition and formulate an anesthetic plan which takes that patient's physical condition into account.

It is vital that the anesthesiologist knows as much about your medical history, lifestyle, and medications as possible. Some particularly important information he/she needs to know includes the following:

If you have ever had a bad reaction to an anesthetic agent, you need to be able to describe exactly what the reaction was and what your specific symptoms were. Give the anesthesiologist as much detail as possible, such as you felt nauseated when you woke up or the amount of time it took you to wake up, etc.

Monitoring is one of the most important roles the anesthesiologist handles during surgery. Second-by-second observation of even the slightest changes in a wide range of body functions gives the anesthesiologist a tremendous amount of information about the patient's well-being.

In addition to directing your anesthesia, the anesthesiologist will manage vital functions such as heart rate, blood pressure, heart rhythm, body temperature, and breathing. He/she will also be responsible for fluid and blood replacement, when necessary. Sophisticated technology is used to monitor every organ system and its functioning during surgery.